The patient in this case presented with a 3-day history of colicky generalised abdominal pain, gradually getting worse and eventually localising to the right iliac fossa (classical symptoms of acute appendicitis).

A provisional diagnosis of acute appendicitis was made, and consent was taken for appendicectomy. During the operation, a small (2 mm) perforation was found in the distal sigmoid colon through which a chicken bone was protruding outward.

Fewer than 1% of ingested foreign bodies will perforate the bowel. Although most sharp objects pass without complications, once beyond the oesophagus, they carry an increased risk of complications.

Diagnosis of an intestinal perforation can be difficult and the authors emphasise the need for a high degree of suspicion and awareness on the part of the clinician. They stress that situations such as these highlight the importance of obtaining full consent from the patients; this is particularly important when there is a diagnostic dilemma, as this may have future medico-legal implications. It is important to inform patients about an alternative diagnosis.

Our deputy editor said: “Excellent and intreresting case, also very well written“.